Claudia De Rosa
I do anatomize and cut up these poor beasts, he said to Hippocrates, to see the cause of these distempers, vanities, and follies, which are the burden of all creatures. – Democritus, from The History of Melancholy
When today’s doctor prescribes an antibiotic to fight infection, he is trying to put the patient’s body back in balance. While the drugs and medical explanation may be new, this art of balancing bodily fluids has been practiced since Hippocrates‘ day. In the Hippocratic corpus (believed notto be the work of a single man of that name) disease was thought to be caused by isonomia, the preponderance of one of the 4 bodily humors:
- Yellow Bile
- Black Bile
- Phlegm
- Blood
Four humors matched the four seasons
- Autumn: black bile
- Spring: blood
- Winter: phlegm
- Summer: yellow bile.
(See: Hippocratic Diseases by Season)
Each of the humors was associated with one of the four equal and universal elements (earth, air, fire, and water) posited by Empedocles:
Aristotle, who used the image of wine to expose the nature of black bile. Black bile, just like the juice of grapes, contains pneuma, which provokes hypochondriac diseases like melancholia. Black bile like wine is prone to ferment and produce an alternation of depression and anger…. -From The History of Melancholy
- Earth: black bile
- Air: blood
- Fire: yellow bile
- Water: phlegm
Too much earth made one melancholic; too much air, sanguine; too much fire, choleric; and too much water, phlegmatic.
Too much Earth: Melancholic
Too much Air: Sanguine
Too much Fire: Choleric
Too much Water: Phlegmatic
Finally, each element/humor/season was associated with certain qualities. Thus yellow bile was thought of as hot and dry. Its opposite, phlegm (the mucus of colds), was cold and moist. Black Bile was cold and dry, while its opposite, blood was hot and moist.
Black Bile: Cold and Dry
Blood: Hot and Moist
Phlegm: Cold and Moist
Yellow Bile: Hot and Dry·
As a first step, the prudent Hippocratic physician would prescribe a regimen of diet, activity, and exercise, designed to “void the body of the imbalanced humor.” According to Gary Lindquester’s “History of Human Disease,” if it was a fever — a hot, dry disease — the culprit was yellow bile. So, the doctor would try to increase its opposite, phlegm, by prescribing cold baths. If the opposite situation prevailed (as in a cold), where there were obvious symptoms of excess phlegm production, the regimen would be to bundle up in bed and drink wine.
If this didn’t work the next course would be with drugs, often hellebore, a potent poison that would cause vomiting and diarrhoea, “signs” the imbalanced humor was eliminated.
We might assume such Hippocratic ideas sprang from speculation rather than experimentation, but observation played a key role. Furthermore, it would be simplistic to say ancient Greco-Roman doctors never practiced human dissection. If nothing else, doctors had anatomical experience dealing with war wounds. But especially during the Hellenistic period, there was extensive contact with the Egyptians whose embalming techniques involved removing bodily organs. In the third century B.C. vivisection was permitted in Alexandria where living criminals may have been put to the knife. Still, we believe Hippocrates, Aristotle, and Galen, among others, only dissected animal bodies, not human.
So man’s internal structure was known primarily through analogy with animals, inferences from the externally visible structures, from natural philosophy, and from function.
Such ideas might seem far-fetched today, but Hippocratic medicine was a great advance over the supernatural model that had preceded it. Even if individuals had understood enough about contagion to realize rodents were involved somehow, it was still the Homeric Apollo, the mouse god, who caused it. The Hippocratic aetiology based on nature permitted diagnosis and treatment of symptoms with something other than prayer and sacrifice. Besides, we rely on similar analogies today, in Jungian personality types and ayurvedic medicine, to name two.
These men demonstrated that when the nutriment becomes altered in the veins by the innate heat, blood is produced when it is in moderation, and the other humours when it is not in proper proportion. -Galen On the Natural Faculties Bk II
In traditional medicine practiced in Greco-Roman civilization and in Europe during the Middle Ages (at least until the Renaissance), humorism, or humoralism, dictated that the four humours were special fluids associated with the four basic elements of nature, that were thought to permeate the body and influence its health. An imbalance in the distribution of these fluids was thought to affect each individual’s personality. The concept was developed by ancient Greek thinkers around 400 BC and was directly linked with another popular theory of the four elements (Empedocles). Paired qualities were associated with each humour and its season.
History
The four humours, their corresponding elements, seasons and sites of formation, and resulting temperaments alongside their modern equivalents are:
The four humours, their corresponding elements, seasons and sites of formation, and resulting temperaments alongside their modern equivalents are:
It is believed that Hippocrates was the one who applied this idea to medicine. “Humoralism” or the doctrine of the Four Temperaments as a medical theory retained its popularity for centuries largely through the influence of the writings of Galen (131-201 AD) and was decisively displaced only in 1858 by Rudolf Virchow’s newly-published theories of cellular pathology. While Galen thought that humours were formed in the body, rather than ingested, he believed that different foods had varying potential to be acted upon by the body to produce different humours. Warm foods, for example, tended to produce yellow bile, while cold foods tended to produce phlegm. Seasons of the year, periods of life, geographic regions and occupations also influenced the nature of the humours formed.
The imbalance of humours, or “dyscrasia”, was thought to be the direct cause of all diseases. Health was associated with a balance of humours, or eucrasia. The qualities of the humours, in turn, influenced the nature of the diseases they caused. Yellow bile caused warm diseases and phlegm caused cold diseases.
In On the Temperaments Galen further emphasized the importance of the qualities. An ideal temperament involved a balanced mixture of the four qualities. Galen identified four temperaments in which one of the qualities, warm, cold, moist and dry, predominated and four more in which a combination of two, warm and moist, warm and dry, cold and dry and cold and moist, dominated. These last four, named for the humours with which they were associated that is, sanguine, choleric, melancholic and phlegmatic, eventually became better known than the others. While the term “temperament” came to refer just to psychological dispositions, Galen used it to refer to bodily dispositions, which determined a person’s susceptibility to particular diseases as well as behavioural and emotional inclinations.
The four temperaments (Clockwise from top right; choleric; melancholic; sanguine; phlegmatic).
Sanguine
Sanguine indicates the personality of an individual with the temperament of blood, the season of spring (wet and hot), and the element of air. A person who is sanguine is generally optimistic, cheerful, even-tempered, confident, rational, popular, and fun-loving. They can be daydreamy to the point of not accomplishing anything and impulsive, acting on whims in an unpredictable fashion. This also describes the manic phase of a bipolar disorder.
Sanguine indicates the personality of an individual with the temperament of blood, the season of spring (wet and hot), and the element of air. A person who is sanguine is generally optimistic, cheerful, even-tempered, confident, rational, popular, and fun-loving. They can be daydreamy to the point of not accomplishing anything and impulsive, acting on whims in an unpredictable fashion. This also describes the manic phase of a bipolar disorder.
Choleric
Choleric corresponds to the fluid of yellow bile, the season of summer (dry and hot), and the element of fire. A person who is choleric is a doer and a leader. Many great charismatic, military and political figures were cholerics. On the negative side, they are easily angered or bad tempered.
Choleric corresponds to the fluid of yellow bile, the season of summer (dry and hot), and the element of fire. A person who is choleric is a doer and a leader. Many great charismatic, military and political figures were cholerics. On the negative side, they are easily angered or bad tempered.
In folk medicine, a baby referred to as “cholic” is one who cries frequently and seems to be constantly angry. This is an adaptation of “choleric,” although no one now would attribute the condition to bile. Similarly, a person described as “bilious” is mean-spirited, suspicious, and angry. This, again, is an adaptation of the old humour theory “choleric.”
The disease Cholera gained its name from choler (bile).
Melancholic
Melancholic is the personality of an individual characterized by black bile; a person who was a thoughtful ponderer had a melancholic disposition. Often very kind and considerate, melancholics can be highly creative – as in poets and artists – but also can become overly obsessed on the tragedy and cruelty in the world, thus becoming depressed. It also indicates the season of autumn (dry and cold) and the element of earth. A melancholy is also often a perfectionist, being very particular about what they want and how they want it in some cases. This often results in being unsatisfied with one’s own artistic or creative works, always pointing out to themselves what could and should be improved.
Melancholic is the personality of an individual characterized by black bile; a person who was a thoughtful ponderer had a melancholic disposition. Often very kind and considerate, melancholics can be highly creative – as in poets and artists – but also can become overly obsessed on the tragedy and cruelty in the world, thus becoming depressed. It also indicates the season of autumn (dry and cold) and the element of earth. A melancholy is also often a perfectionist, being very particular about what they want and how they want it in some cases. This often results in being unsatisfied with one’s own artistic or creative works, always pointing out to themselves what could and should be improved.
This temperament describes the depressed phase of a bipolar disorder.
Phlegmatic
A phlegmatic person is calm and unemotional. Phlegmatic means pertaining to phlegm, corresponds to the season of winter (wet and cold), and connotes the element of water.
A phlegmatic person is calm and unemotional. Phlegmatic means pertaining to phlegm, corresponds to the season of winter (wet and cold), and connotes the element of water.
While phlegmatics are generally self-content and kind, their shy personality can often inhibit enthusiasm in others and make themselves lazy and resistant to change. They are very consistent, relaxed, and observant, making them good administrators and diplomats. Like the sanguine personality, the phlegmatic has many friends. But the phlegmatic is more reliable and compassionate; these characteristics typically make the phlegmatic a more dependable friend.
Within an individual, the phlegmatic personality is considered to be compatible with the sanguine and melancholic traits — the melancholic personality is too perfectionist, and the choleric is too controlling. Combinations of two incompatible traits may be evidence of masking.
When the theory of the temperaments was on the wane, many critics dropped the phlegmatic, or defined it purely negatively as the absence of temperament. This, however, made it available for the German philosopher Immanuel Kant to reclaim as the temperament appropriate to freedom and virtue. In five-temperament theory, the classical Phlegmatic temperament is in fact deemed to be a neutral temperament, whereas the “people-liking introvert” position traditionally held by the Phlegmatic is declared to be a new “fifth temperament”
Methods of treatment like blood letting, emetics and purges were aimed at expelling a harmful surplus of a humour. They were still in the mainstream of American medicine after the Civil War. Other methods used herbs and foods associated with a particular humour to counter symptoms of disease, for instance: people who had a fever and were sweating were considered hot and wet and therefore given substances associated with cold and dry.
There are still remnants of the theory of the four humours in the current medical language. For example, we refer to humoral immunity or humoral regulation to mean substances like hormones and antibodies that are circulated throughout the body, or use the term blood dyscrasia to refer to any blood disease or abnormality. The associated food classification survives in some apparently illogical adjectives that are still used for food, as when we call some spices hot and some wine dry. When the chilli was first introduced to Europe in the sixteenth century, dieticians disputed whether it was hot or cold.
The theory was a modest advance over the previous views on human health that tried to explain in terms of the divine. Since then practitioners have started to look for natural causes of disease and to provide natural treatments.
Modern adaptations
A few psychologists use the four-temperament model even today, some also recognizing twelve mixtures of the four temperaments: Mel-Chlor, Chlor-San, San-Phleg, Phleg-Mel, Mel-San, Chlor-Phleg; and the reverse of these: Chlor-Mel, San-Chlor, Phleg-San, Mel-Phleg, San-Mel, and Phleg-Chlor. These represent people who have the traits of two temperaments. The order of temperaments in these pairs was based on which temperament was the “dominant” one (this is usually expressed by percentages). A person can also be a blend of three temperaments.
A few psychologists use the four-temperament model even today, some also recognizing twelve mixtures of the four temperaments: Mel-Chlor, Chlor-San, San-Phleg, Phleg-Mel, Mel-San, Chlor-Phleg; and the reverse of these: Chlor-Mel, San-Chlor, Phleg-San, Mel-Phleg, San-Mel, and Phleg-Chlor. These represent people who have the traits of two temperaments. The order of temperaments in these pairs was based on which temperament was the “dominant” one (this is usually expressed by percentages). A person can also be a blend of three temperaments.
In Steiner (Waldorf) education and anthroposophy, the temperaments are used to help understand personality. They are seen as avenues into teaching, with many different types of blends, which can be utilized to help with both discipline and defining the methods used with individual children and class balance. The Unani school of Indian medicine, still apparently practiced in India, is very similar to Galenic medicine in its emphasis on the four humours, and in treatments based on controlling intake, general environment, and the use of purging as a way of relieving humoral imbalances.
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